张力,高玥,刘纪廷,于政民,刘啸文,徐酩,张恒东
ZHANG Li,GAO Yue,LIU Jiting,YU Zhengmin,LIU Xiaowen,XU Ming,ZhANG Hengdong

• 1:江苏省疾控中心职业病防治所
• 2:苏州大学公共卫生学院

摘要(Abstract)：

目的:比较4种方法治疗慢性职业性铅中毒的临床疗效。方法:将248例慢性职业性铅中毒患者随机分为A组(依地酸钙钠治疗组)、B组(依地酸钙钠联合水溶性维生素治疗组)、C组[二巯基丁二酸(DMSA)治疗组]及D组(DMSA联合水溶性维生素治疗组); 28 d时观察4组患者的血铅、锌原卟啉(ZPP)、血红蛋白(Hb)、CD3+比例、CD4+比例、CD8+比例及CD4+/CD8+比值,比较治疗有效率。结果:与治疗前比较,治疗后4组慢性职业性铅中毒患者血铅及ZPP均显著下降(P <0. 05),血铅下降程度为D组> B组> A组及C组(P <0. 05),ZPP下降程度为D组> B组及C组> A组(P <0. 05);治疗后4组患者Hb水平、CD3+比例、CD4+比例、CD8+比例及CD4+/CD8+比值均明显升高,且B组及D组CD4+比例及CD4+/CD8+比值高于A组及C组,差异具有统计学意义(P <0. 05); 4组治疗有效率均> 75%,治疗效果从高到低依次为D组及B组> A组及C组(P<0. 05)。结论:DMSA或依地酸钙钠联合水溶性维生素治疗慢性职业性铅中毒较单独应用疗效更佳。
Objective: To analyze and compare the clinical efficacy of four methods in the treatment of chronic occupational lead poisoning. Methods: 248 enrolled chronic occupational lead poisoning patients( since 2015 to 2017) were randomly divided into four groups,named A group( calcium sodium edetate group),B group( calcium sodium edetate combined with water-soluble vitamins group),C group( the DMSA group),and D group( the DMSA combined with water-soluble vitamins group).The Observation of blood lead,zinc protoporphyrin( ZPP),hemoglobin( Hb),CD3+ratio,CD4+ratio,CD8+ratio and CD4+/CD8+ratio of the 4 groups were recorded at 28 days and the treatment efficiency was compared. Results: Compared with the untreated period,the blood lead and ZPP levels of patients were significantly decreased( P < 0. 05) in 4 groups after treatment,and the therapeutic efficiencies were over 75% in all four therapy groups. The tendency of decline degree of blood lead levels were D group > B group > A group/C group( no difference displayed between this two group)( P <0. 05). For ZPP concentration,the D group displayed the most decline trend,followed by B group/C group and A group( P < 0. 05). The trend of therapeutic efficiencies were D group/B group( no difference displayed between the two groups) > A group > C group( P < 0. 05). No significant distinct existed in the Hb values of these four groups. And for immune indexes,there were enormous statistic significances in CD4+activity,CD8+activity,and ratio of CD4+/CD8+of four treatment groups( P <0. 05). Conclusion: Based on the decline of blood lead level and therapeutic efficiency,the DMSA combined with water-soluble vitamins may be the outstanding therapy of chronic occupational lead poisoning with an excellent lead discharge effect and can be selected or popularized in clinic.

关键词(KeyWords)： 铅中毒;职业病;二巯基丁二酸;依地酸钙钠;维生素类;疗效
lead poisoning;occupational disease;Meso-2,3-dimercaptosuccinic acid;calcium sodium edetate;vitamins;clinical efficacy

Abstract:

Keywords:

基金项目(Foundation): 江苏省科技项目临床医学科技专项(BL2014082);; 江苏省医学青年人才项目(QNRC2016548)

作者(Author): 张力,高玥,刘纪廷,于政民,刘啸文,徐酩,张恒东
ZHANG Li,GAO Yue,LIU Jiting,YU Zhengmin,LIU Xiaowen,XU Ming,ZhANG Hengdong

DOI: 10.19367/j.cnki.1000-2707.2018.12.018

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